Healthcare Provider Details

I. General information

NPI: 1750185708
Provider Name (Legal Business Name): IMPULSO VITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B3 CALLE MARGINAL URB VILLA LISSETTE
GUAYNABO PR
00969-3421
US

IV. Provider business mailing address

B3 CALLE MARGINAL URB VILLA LISSETTE
GUAYNABO PR
00969-3421
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-6570
  • Fax:
Mailing address:
  • Phone: 787-999-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: HERNAN N LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 787-671-7088